Published in PLOS One on 2026-08-03, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Sue-Ann Meehan, Anneke C Hesseling, Emma Kalk, Jennifer A Hughes, James A Seddon, Victoria E Namukuta, Muhammad Osman
Source: PLOS One • DOI 10.1371/journal.pone.0344059
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Tuberculosis (TB) incidence peaks in women during their reproductive years and is a leading cause of maternal mortality. Pregnant women with TB have a high risk of failure to initiate TB treatment and poor TB treatment and pregnancy outcomes. We determined the time to treatment initiation in pregnant women diagnosed with TB in a routine programmatic setting.
Using routine linked electronic data, we identified women 15–45 years of age with laboratory-confirmed and/or clinically diagnosed TB, October 2018-December 2020, in two high-burden sub-districts in Cape Town, South Africa. We compared demographic and clinical characteristics in women with TB by pregnancy status, used time-to-event analysis to determine the time from TB diagnosis to initiation of antituberculosis treatment and Cox regression to assess determinants of treatment initiation.
Of 5,459 women diagnosed with TB, 292 (5.3%) were pregnant. The median age for pregnant women was 28.6 years (interquartile range [IQR]: 23.7–33.7) and non-pregnant women 31 years (IQR:25.2–36.5). HIV prevalence was similar in pregnant (177/292; 60.6%) vs non-pregnant (3200/5167; 61.9%) women. Median time to treatment initiation was two days for pregnant and non-pregnant women. Most (92% of non-pregnant and 89% of pregnant) women initiated treatment within the first month after their TB diagnosis, after which the rate plateaued in both groups. Time to treatment initiation over 6 months was statistically different (Kaplan Meier Log-rank test, p = 0.0064) with pregnant women lagging behind non-pregnant women.
More than 5% of women diagnosed with TB were pregnant at the time of TB diagnosis. While pregnant women with TB were appropriately initiated on treatment, almost 15% were never started on treatment and there were delays in treatment initiation. While strategic interventions to prioritise early treatment initiation are needed, there should be a specific focus on pregnant women who have not initiated treatment within one month after TB diagnosis.
Introduction
Globally, an estimated 10.7 million people developed tuberculosis (TB) disease in 2024, of whom 3.7 million (35%) were women [1]. TB incidence peaks in women during the reproductive years [2–4] and is a leading cause of mortality among women of childbearing age [5] Globally, an estimated 239,300 pregnant and 97,600 postpartum women developed TB in 2023 [6]. Pregnant women with TB have poor TB treatment outcomes [7,8] and their babies are at high risk of premature birth, low birthweight and stillbirth [8–11]. Failure to initiate TB treatment is a predictor of adverse pregnancy outcomes [12]. Prompt initiation of TB treatment is therefore critical for all newly diagnosed individuals, especially pregnant women, to improve both TB treatment and maternal and neonatal outcomes.
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider research & evidence desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Sue-Ann Meehan, Anneke C Hesseling, Emma Kalk, Jennifer A Hughes, James A Seddon, Victoria E Namukuta, Muhammad Osman. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
Explore connected evidence
- Evidence brief: Predictors of tuberculosis mortality among patients on treatment: A retrospective cohort study at a rural general hospital in Zambia
- Evidence brief: The impact of expanded access to antiretroviral treatment on engagement in HIV care and viral suppression among pregnant women living with HIV in South Africa
- Evidence brief: Virologic suppression among HIV-positive pregnant and lactating women receiving antiretroviral therapy in Africa: A systematic review and meta-analysis
